Korean Journal of Gastrointestinal Endoscopy 1996;16(3): 397-405.
원저 : 식도 위장관 : 식도정맥류 출혈에 대한 내시경적 결찰요법과 예방적 결찰요법의 비교 ( Original Articles : Esophagus , Stomach & Intestine ; Prophylactic Endoscopic Variceal Ligation Compared with Endoscopic Variceal Ligation for Bleeding Esophageal Varices )
박홍배, 강명원, 정경헌, 이재학, 김기현, 문정식, 박철성, 여향순 (Hong Bae Park, Myung Weon Kang, Gyeong Heon Jeong, Jae Hak Lee, Kee Hyeon Kim, Jung Sik Moon, Chul Sung Park and Hayang Soon Yeo)
Abstract
Endoscopic Variceal Ligation(EVL) was developed as an alternative to endoscopic injection sclerotherapy(EIS) for decreasing of complication rate. This new technique involves placement of small elastic O-rings around the variceal channels in the distal esophagus. To evaluate the efficacy of EVL for treatment of the acute bleeding esophagea1 varices and the efficacy of prophylactic EVL, we compared EVL in 88 patients who had recently bled from esophageal varices(Group 1) and prophylactic EVL in 45 patients with large size(Grade 2 or 3 or 4) and red color sign on endoscopic finding who had not previously had upper gastrointestinal bleeding(Group 2). Also, we compared prophylactic EVL group(Group 2) and control group(Group 3) who did not performed EVL. At the time of treatment 28.4%(25/88) of patients had active bleeding. They were all treated acutely with EVL and repeated treatment for the long-term goal of variceal eradication. Initial hemostatic efficacy of EVL for acute bleeding varices was 92%(23/25). Varices were eradicated or reduced to Grade 1 in 68%(17/2S). Early mortality rate within 2 weeks was 8%(2/25). Among patients who had eradicated or reduced to Grade 1 varices by repeated EVL sessions, over a mean follow-up of 11 months there was no difference between Group 1 and Group 2 in recurrent rate(49.1%(27/63) vs. 46.8% (15/32)), rebleeding rate(10.9'Yo (6/55) vs. 9.3% (3/32)), rebleeding interval(average 75 days vs, 83.6 days). There was significant difference between prophylactic EVL group and con- trol group in bleeding rate(9.3%(3/~32) vs. 43.7%(14/32))~(p<0.05). Three patients(6.6%) died in prophylactic EVL group, two from ligation site bleeding of esophageal varix, one from hepatic failure. In conclsion, EVL is an effective method for treatment of acute bleeding esophageal varices with repeated sessions. Although prophylactic EVL can be used to prevent bleeding by eradication with lower initial morbidity are necessary because of EVL-related complications.(Korean J Gastrointes Endosc 16: 397~405, 1996)